Deinstitutionalization

Deinstitutionalization refers to the mid-20th-century shift away from housing people with serious mental illness in large state psychiatric hospitals and toward treating them in community-based settings such as outpatient clinics, group homes, and community mental health centers. Over the following decades, the population of U.S. state mental hospitals fell dramatically from its 1950s peak.

Several forces converged to drive the change. The introduction of chlorpromazine, the first antipsychotic medication, in the 1950s made it possible to manage psychotic symptoms outside a hospital. Exposés of overcrowded, inhumane asylum conditions fueled a patients' rights movement, and courts increasingly held that people could not be confined if they posed no danger. Governments also saw community care as far less expensive than institutional care. The Community Mental Health Act of 1963 formalized the shift by funding a national network of community mental health centers.

The legacy is mixed. Deinstitutionalization freed many people from unnecessary confinement and pushed treatment toward less restrictive settings, but the community services meant to replace hospitals were chronically underfunded. Researchers link the resulting treatment gap to elevated rates of homelessness and incarceration among people with serious mental illness — a pattern sometimes called transinstitutionalization.

The AP Psychology exam covers deinstitutionalization in its unit on the treatment of psychological disorders — know what drove the movement, the role of antipsychotic medication, and its intended and unintended consequences.